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目的通过对有输血史的恶性疟疾感染者进行检测和溯源分析,确定其传染源和传播方式。方法对患者和为其输血的8名献血者血样进行疟疾快速检测、血涂片镜检和Real-time PCR检测,并对阳性血样进行分子溯源和基因分型。结果患者与1名非洲返乡献血者在疟疾快速诊断试剂检测、血涂片镜检和Real-time PCR 3项检测中,均显示为恶性疟阳性。两者血样SSU rRNA基因序列两两比对后同源性为100%,Pf EMP-1基因分型显示受血者和献血者血样均为恶性疟原虫K1型和MD20型混合感染。确定该患者的恶性疟确因输入非洲返乡献血者的血液而感染。讨论由于我国未将疟疾筛查列入献血前检测,因此境外返乡人员在疟疾潜伏期或复发期内参加献血易引起输血传播疟疾。采供血机构需仔细征询既往病史和外出史,并加强宣教,将经血传播的疾病控制在源头。
Objective To detect and trace the malignant malaria patients who have the history of blood transfusion and determine the source of infection and the mode of transmission. Methods Rapid blood tests of malaria, blood smear microscopy and Real-time PCR were performed on the blood samples of 8 blood donors and their blood transfusions. The positive blood samples were also traced for molecular tracing and genotyping. Results The patients and one returning blood donor from Africa showed positive for P. falciparum in the three tests of rapid diagnostic reagent for malaria, blood smear microscopy and Real-time PCR. The homology of the SSU rRNA gene sequences of the two blood samples was 100%. The genotypes of Pf EMP-1 showed that the blood samples from recipients and donors were both mixed infection of Plasmodium falciparum K1 and MD20. It was confirmed that the patient’s falciparum malaria was actually infected by the blood entering the blood donors returning to Africa. Discussion As China does not include malaria screening in pre-donation testing, returning overseas returnees can easily cause blood transfusion and malaria during blood donation during the incubation period or recurrence of malaria. Blood collection and supply agencies need to consult history and out of history, and to step up education, the blood-borne disease control at the source.